» Texas HEAT Rounds Up More DME Medicare Fraud

Texas HEAT Rounds Up More DME Medicare Fraud

15. March 2010

‘Arthritis kit’ fraudsters make it harder for legitimate orthotics providers to do their business. If you’ve been reading about Medicare fraud schemes involving ‘arthritis kits,’ and like me, you’re wondering how these schemes work,

Professional Whistleblower Nabs Another Hospital for False Outlier Payments

5. March 2010

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Hospital billing consultant knew exactly how to blow the whistle — and gets $613,000 for his trouble. Brookhaven Memorial Hospital Medical Center in Long Island, NY will pay the federal government $2.92 (excluding interest) to settle…

Mercy Medical Center Pays $2.8 Million Settlement

1. March 2010

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Lack of documentation for IRF services the crux of case The federal government gets a $2.8 million settlement from Mercy Medical Center after the hospital admitted it violated the False Claims Act some three years ago by…

Audit Hot Spot: When HCPCS Coding Confusion Leads to Overpayments

25. February 2010

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Here’s where your electronic billing system may be grabbing overpayments by mistake. At first glance, they don’t look like much — two recent OIG reports, one examining oxaliplatin billing from a Seattle facility, and

Internal Auditor Turns Whistleblower at Cardiology Practice

4. January 2010

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Upcoding E/M services at heart of the case An internal auditor turned whistleblower when she felt a Michigan cardiology practice was ignoring her concerns about evaluation & management upcoding. A $669,413 settlement with the Department of Justice is the end result.…

Latest on Home Health Fraud Busts

7. December 2009

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76K for “vacation pay?” Where can we get a gig like that? Recent fraud busts are threatening home care providers with a bad reputation. In Memphis, an owner of a 30-year-old home health agency was sentenced to 18 months in…

Former HealthSouth Exec Must Do Time, Appeals Court Says

23. November 2009

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$41K a day to maintain Scrushy’s yacht — plus other tidbits from the compliance case that just won’t die. Former HealthSouth Chief Information Officer Kenneth Livesay should go to prison for his role in HealthSouth’s now-legendary $2.7 billion accounting fraud that…

DOJ: 2 SNF Chains & Their Principles Named In Omnicare, Risperdal Complaint

9. November 2009

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At issue: The antipsychotic drug Risperdal & fair market value. Last week, the Department of Justice announced that nation’s largest nursing home pharmacy, Omnicare Inc., will pay $98 million to settle False Claims Act allegations. IVAX Pharmaceuticals (now a subsidiary of…

‘Sub-Standard Care’ the Crux of Medicaid FCA Case

9. November 2009

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Therapists formerly employed at a residential treatment center blow the whistle. Many times, False Claims Act cases in health care hinge on the fact that claims were submitted to Medicare or Medicaid when no actual care was provided at all.…

How One Hospital’s Physician Gifts Ran Afoul of Stark

12. October 2009

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One lesson learned: A central tracking system can flag multiple gifts. Your hospital can learn a lot from the mistakes of others, especially when it comes to the slippery Stark rules. On June 26, 2009, the…

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